Primary incisional hernia repair with or without polypropylene mesh: a report on 384 patients with 5-year follow-up.

BACKGROUND AND AIM: Several studies have claimed that mesh repair of incisional hernia lowers recurrence rates when compared to suture repair. We investigated the relative effectiveness of mesh and suture repair in a large homogeneous cohort of patients with primary incisional hernia.

PATIENTS AND METHODS: In a retrospective single-centre cohort study, a total of 446 consecutive patients were identified, of whom 86% could be followed up. Mean length of follow-up was 5 years. In 79 patients (22%), we implanted a mesh, usually polypropylene (Prolene).

RESULTS: Compared to suture repair, mesh repair prolonged operating time by over 30 min and caused seroma in 12.7% of the patients (p<0.001). Only 4 of the 79 patients with mesh repair developed recurrence, compared to 55 of the 305 patients with suture repair (5 vs 18%, p=0.02 by log-rank test). In multivariate Cox regression, recurrence rates were fourfold higher after suture than after mesh repair (p=0.02). Interestingly, old age was associated with a decreased susceptibility for recurrence (p=0.01).

CONCLUSION: Our data confirms the long-term effectiveness of mesh repair under routine conditions. Suture repair should be restricted to small hernias in patients free of known risk factors.